Anterior approach to the forearm (Henry)
Approaches FMH Prüfung
Approaches FMH Prüfung
Fichier Détails
| Cartes-fiches | 11 |
|---|---|
| Langue | Deutsch |
| Catégorie | Médecine |
| Niveau | Autres |
| Crée / Actualisé | 21.10.2012 / 23.11.2017 |
| Lien de web |
https://card2brain.ch/box/anterior_approach_to_the_forearm_henry
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| Intégrer |
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Internerval Plane anterior approach to the forearm
Surgical Interval is between Pronator Teres (median n.) and Brachioradialis (rad n.) proximally and between Brachioradialis (radial n.) and FCR (median n.) distally.
Bildliche Darstellung internervous plane forearm
internervous plane
Superficial dissection anterior approach to the forearm
Incise the deep fascia in line with skin incision
Develop a plane between BR and FCR distally
Move proximal to develop plane between PT and BR
Identify the superficial radial nerve beneath BR
Ligate the branches
Deep dissection - proximal third anterior approach to the forearm
Follow the biceps tendon to its insertion on the bicipital tuberosity
Radial to the insertion of biceps tendon incise the bursa to gain access to the proximal part of radius (radial artery which runs along the ulnar side of the biceps tendon)
Fully supinate the forearm to displace the PIN radially and bring the origin of the supinator muscle into the anterior aspect of the radius
Incise the supinator muscle along the line if its broad insertion and continue subperiosteal dissection laterally
Deep dissection - middle third anterior approach to the forearm
pronate the forearm to bring the insertion of the pronator teres, along the radial aspect of the radius, into view
detach the pronator insertion from bone and retract medially
Deep dissection - distal third anterior approach to the forearm
partially supinate the forearm
dissect the periosteum off the lateral aspect of the distal third of the radius, lateral to the pronator quadratus and flexor pollicis longus
Dangers anterior approach to the forearm
Posterior interosseous nerve
the posterior interosseous nerve enters the supinator muscle beneath a fibrous arch known as the arcade of Frohse.
the arch is formed by the thickened edge of the superficial head of the supinator muscle.
compression of the nerve at this point produces paralysis or dysfunction of the extensors known as posterior interosseous nerve entrapment syndrome
step to protect the PIN include
dissecting supinator off radius subperiostally
do not place retractors on posterior surface of radial neck
avoid excessive radial retraction of supinator
supinating the forearm to move PIN away from the surgical field
Dangers anterior approach to the forearm (2+3)
Superficial radial nerve
runs down forearm under body of brachioradialis
vulnerable with manipulation of mobile wad of three
damage to it can cause a painful neuroma
Radial artery
runs down middle of forearm under brachioradialis
Incision for the anterior approach to the forearm
longitudinal incision
begin just lateral to biceps tendon on flexor crease of elbow
end at radial styloid process
Indications for anterior approach to the forearm
ORIF of radius fxs
radial osteotomy
tumor / abscess biopsy and excision
anterior exposure of bicipital tuberosity
superficial radial nerve compression syndrome (Wartenberg Syndrome)
Interval anterior approach to the forearm
Proximally between
brachioradialis (radial n.) and PT (median n.)
distally between
brachioradialis (radial n.) and FCR (median n.)
